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The Rehab Zone
by Ken Lavelle

Understanding firefighters and cancer

While we cannot wipe out cancer, understanding its nature and the special risk to firefighters allows us to take steps to reduce its occurrence and severity

By Kenneth G. Lavelle, MD, FACEP, FF/NREMT-P

Over the past several years, there has been an increase in discussions regarding the risk of cancer in firefighters. These discussions have both occupational health and economic implications so are often quite lively between firefighters and their unions, and the municipal government and insurance companies. 

Few would challenge that the 74-year-old firefighter with lung cancer who has smoked two packs per day for 50 years, at least may have developed it due to the smoking rather than firefighting activities. But when the 36-year-old firefighter develops testicular cancer, considered to be rare, one has to wonder. 

We owe it to millions of current and future firefighters to determine the truth regarding the occupational risk of our work and its relation to cancer.

What is cancer?
Cancer occurs when abnormal cells divide without control and are able to invade other tissues. To understand how this can happen, we need to understand what is normal in cells. 

Cells are the body's basic unit of life. Everyday cells divide and grow to make new cells. But the key is that they know when to stop. 

New liver cells do not continue to grow and divide and take up the entire abdomen, for example. Something innate causes them to stop — this is usually coded in the genetic material of the cell, the DNA.

Sometimes, this DNA becomes damaged. This can result in the cell not dying when it should or growth not stopping when it should.

This may result in a tumor, or a mass of cells. This tumor may be benign — it does not spread and is not cancer. Or, it may be malignant, or cancerous.

Why DNA is damaged
There are a number of reasons why DNA becomes damaged. First, the abnormal DNA may have been inherited from a previous cell. There is a mistake in the DNA that is passed on to the daughter cell when the first one divides. 

The abnormal DNA also could have been inherited from the mother or father of the patient.

Second, at the time of the cell division the DNA is copied and a mistake might occur. Imagine the kids' game of "telephone" — as a message goes down the line sometimes the information changes. 

The same thing can happen when the DNA is copied — mistakes happen. In many cases the body is able to detect these mistakes and fix them, but not always.

Third, the DNA in a cell can change or mutate as a result of an environmental exposure. This is the cause that many of us are most concerned about. This exposure may be from chemicals, sunlight, smoking or even a virus. 

The substance can cause the DNA molecules to change. Sometimes this causes the cell to die, and there is no long-term problem. Other times it modifies the cell and allows it to become cancerous.

In many cancer patients there is a combination of all of these. That is why one firefighter who smokes and is exposed to chemicals all day might not get cancer, and another does. Perhaps the firefighter (or any patient) has a family history of cancer and is pre-disposed due to other changes in the DNA.

The firefighter's risk
Cancers take a variety of forms — lung, prostate, colon, testicular and breast are just a few of the more than 100 different types. It is a very common condition. In fact, half of all men and one-third of all women will get cancer in their lifetime. 

Most of these are not deadly and may not even cause any symptoms. But out of the estimated 1.6 million cases of cancer to be found this year, 577,000 of them will be fatal to the patient.

So are we as firefighters at increased risk over the general public for developing cancer? I believe the answer is yes, but there are many different occupations that are at higher risk. 

The issue is what are we exposed to that contributes to this risk? Some of the environmental insults for firefighters include exhaust, soot, smoke and chemical that are inhaled or absorbed through the skin. 

One of the research studies from a few years ago, by Drs. Ash Genaidy and James Lockey at the University of Cincinnati, was published in the Journal of Occupational and Environmental Medicine. They found a number of cancers that firefighters have an increased risk of developing, including testicular cancer and non-Hodgkin's lymphoma. 

They comment that one of the best ways to reduce our risk is to minimize our exposure — properly fitting protective equipment and washing soot off our bodies as soon as possible are just two examples.

Many states have started to recognize the risk and association of firefighting with cancer, and are including a number of cancers in the list of work-related illnesses. That is a good thing. 

However, at the same time, we have to recognize that there are things we can do to decrease this risk by various lifestyle changes. Eating better, quitting smoking and getting regular exercise are good places to start, as well as getting regular checkups and cancer screening so cancers that may be present can be found early when treatment will be more effective. 

This won't eliminate all cancers, but maybe it will decrease the number of deaths that cancer causes, even if just by a small amount.

Stay safe.

About the author

The Rehab Zone. Kenneth G. Lavelle, MD, FACEP, FF/NREMT-P, is Clinical Instructor of Emergency Medicine at Jefferson Medical College, Philadelphia, and Attending Physician at CapitalHealth, Trenton, N.J. He was previously an attending physician at Albert Einstein Medical Center, and previously spent 14 years working as a firefighter and EMS provider.

Ken can be contacted via e-mail at Ken.Lavelle@firerescue1.com.


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